United Bristol Healthcare NHS Trust
Division of Women & Children’s Services
Independent Review of the Congenital Paediatric Cardiac Services Recommendations – Action Plan
Recommendations
Progress to Date
Actions
Leads
(Overall lead in
bold, others are
key contriubtors)
Timescale
Completion
Date
1. Bristol/Cardiff
relationship:
Re-assessment of present
integration and unified
working between the centres.
Telemedicine trials are set up to
facilitate MDT discussions
To set up 6 monthly joint service
away days.
Joint appraisal meeting for fetal
cardiology pathway
Attendance at annual audit of
cardiac surgery/cardiology with
HCW
Dr Andrew Tometzki
3 months
June 2008
Encourage Cardiff representation at
monthly Cardiac Business
meetings.
This month
March 2008
Establish robust telemedicine links
with Cardiff – trials using N3
scheduled
6 months
September 2008
Commence discussion regarding
renaming the service to recognise
South Wales Partnership
6 months
September 2008
2. Consultant Staffing:
The appointment of an
additional Consultant in
Paediatric Cardiology. It
should be addressed by
management with urgency.
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To address workload concerns a
reduction in current Consultant PAs
has been agreed to fund a 7th post
To be presented to TEG for
agreement and sign off March 2008
Dr Jackie Cornish
Geraldine Johnston
Dr Andrew Tometzki
This month
March 2008
Job description and job plan
completed.
Post to be advertised nationally and
internationally
Dr Andrew Tometzki
Geraldine Johnston
3 months
June 2008
College approval confirmed
Presented to DMB for agreement
and sign off February 2008
Working with advertising agency to
develop advert
3. Consultant Staffing:
The needs of the GUCH
service require separate
consideration.
Due to pressures of GUCH work Dr
Stuart removed from paediatric on
call rota May 2007
Clear definition within the job plan in
relation to paediatric and GUCH
commitments within W&C and
Specialised Services Divisions
Dr Jackie Cornish
Dr Peter Wilde
3 months
June 2008
Locum GUCH Consulant appointed
to meet 18 weeks RTT
Business case being developed for
additional consultant in GUCH
Ian Barrington
Dr Mark Turner
3 months
June 2008
Patients on single inotropic support
who would usually incur long stays
on PICU are now treated on Ward
32, guidelines in place.
Review model of care
Dr Andrew Tometzki
Dr Peter Davis
Mr Massimo Caputo
Mr Andrew Parry
William Booth
Judith Armstrong
6 months
September 2008
4. Transitional Care/High
Dependency Care, Ward 32
(BCH)
Additional work is required to
determine whether high
dependency non-ventilated
patients can be accepted
from the PICU without
compromising the admission
of patients for cardiac
catheterisation or
preoperatively.
Establish guidelines/SOPs
Establish strong nursing leadership
for Cardiology/Cardiac Surgery
Review nursing establishment and
skill mix
Assess full utilisation of preadmission clinic and use of pre
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procedure hotel facilities to improve
patient flow
Assimilate with redevelopment
plans for centralisation of Specialist
Paediatric Services
5. Cardiac Catheterisation
(BCH):
The provision of additional
radiography staff and catheter
sessions is required if the
increasing clinical work load
is not to result in excessive
waiting times.
Review of catheterisation sessions
has resulted in improved waiting
times.
Lead Doctor appointed to Division
with remit to support delivery of 18
week referral to treatment time
target (August 2007)
Quantify demand to determine
capacity and workforce required
Ensure recruitment to vacant
Paediatric Cardiac Radiology post
Dr Rob Martin
Dr Mark Callaway
Peter Richardson
Lee Furniss
3 months
June 2008
Dr Rob Tulloh
Dr Mark Turner
Ian Barrington
Geraldine Johnston
6 months
September 2008
Mr Andrew Parry
Rob Tulloh
6 months
September 2008
Assess out of hours radiology cover
in view of 24/7 Acute Angioplasty
Service
6. Pulmonary Hypertension:
Higher recognition for the
Bristol service may be
accorded if Dr Tulloh
developed the service jointly
with adult cardiology or
developed his working
partnership with
Hammersmith Hospital.
It is clear that we have the clinicians
with the skills to take on a PHT
service both in the adult and
paediatric arena.
Dr Tulloh invited to National Clinical
& Commissioning meeting on adult
Pulmonary Hypertension (February
2008)
Divisions to understand financial
implications and operational
development of this service
Dialogue with comissioners required
for Adult PHT service
Consider similar discussion for
paediatric PHT
7. Research Programme:
Dr Tulloh or another identified
individual should be
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Bristol hosted the national British
Congenital Cardiac Association
Explore opportunities for Research
Co-ordinator role and Statistician
encouraged to develop a lead
role in improving the
academic profile of paediatric
cardiology and consolidate
the role of Research Coordinator particularly for junior
staff.
meeting November 2006 to much
acclaim.
from research income
Rob Martin
Prof Andrew Wolf
Mr Massimo Caputo
Review scheduling of
echocardiography
Sue Simpson
Dr Alison Hayes
Lee Furniss
There are a number of strong
clinical researchers. Since
November 2007 weekly congenital
cardiology research meetings have
been set up to focus this work.
8. Echocardiography
(BCH):
Space constraints should be
reviewed with the specialist
paediatric transfer
.
Occupational health/ manual
handling review conducted early
2007. Guidelines set for
echocardographic technicians
6 months
September 2008
12 months
March 2009
Dr Andrew Tomestzki
Sue Simpson
Dr Alison Hayes
6 months
September 2008
Dr Andrew Tometzki
Dr Alison Hayes
1 month
April 2008
Ensure echocardiography
requirments are considered with
development plans for centralisation
of specialist paediatrics transfer.
9. Digital archiving:
The purchase of a system
such as Enconcert/Xcelara
should be given a high
priority.
Representation to the BHI
development group has been made
to highlight the need to have a
seamless digital archiving of
echocardiography images
Assess the additional costs to
archive BCH echo data
Proactive discussion of TOE
requirement now takes place at
cardiac conference therefore on-call
Cardiologist is made aware of
theatre needs
Enusure flexibility with job plans of
Consultant Cardiologists to meet this
recommendation
Assess hardware requirements
10. Echocardiography:
Identification of protected
Consultant time for
transoesophageal echo time
in Theatre required.
A transoesophageal probe
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Paediatric TOE probe in Medical
Equipment Capital Bids - March
should be available in
Theatre at all times. The
purchase/provision of a small
portable echo machine (with
probe) such as the Vivid 1
would provide the best
solution.
A dedicated theatre echo machine
has been funded and ordered (Feb
2008)
2008
Adult TOE probe (for children >
35kg) available for this platform
3D & left ventricular analysis
package purchased February 2008
11. Cardiac Physiologists:
Review of evidence and need
for additional Physiology
Technicians.
Service needs to be assessed,
quantify demand and capacity
Sue Simpson
Dr Alison Hayes
Lee Furniss
3 months
June 2008
Training requirements and CPD of
current staff to be agreed at annual
IDPR
Sue Simpson
Lee Furniss
3 months
June 2008
Dr Andrew Tomestzki
Dr Mark Hamilton
Dr Beverly TsaiGoodman
6 months
September 2008
12. Cardiac Physiologists:
Greater focus and awareness
of need for continuing
professional development.
Well established training links for
student clinical physiolgists in place
Divisional training budget is
available for staff to make
applications for funding
Annual training plan to be devised
13. MRI:
If the future needs of
paediatric and adult
congenital cardiac patients
are to be met, more MRI
sessions will be required. If
these cannot be met within
the Bristol Children’s Hospital
cosideration should be given
to the provision of sessions at
the Bristol Heart Institute.
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Business case has been developed
for provision of MR & CT in BHI
Initial discussions with Dr TsaiGoodman re CPD aims.
Preliminary meetings between Dr
Tsai Goodman & Dr Hamilton have
taken place.
Define working partnership of
paediatric cardiology & adult cardiac
radiology
Define sessions available for
congenital cardiac MRI and
attendant SOPs
14. MRI:
Review of Dr TsaiGoodman’s sessions.
First phase Job planning completed
Complete job plan review
Dr Andrew Tometzki
Dr Beverly TsaiGoodman
Dr Mark Callaway
3 months
June 2008
Service now attracting dedicated
funding since April 2007
Assess demand to quantify
additional workforce requirements
6 months
September 2008
Remote fetal diagnosis in place for
Truro through charity funds.
Programme has expanded to
include Exeter and is attracting an
appropriate/negotiated tariff
Assess need for cardiac liaison
support also required to support
families
Dr Andrew Tometzki
Mr Tim Overton
Mr Pip Mills
Julie Vass
Lee Furniss
Dr Andrew Tometzki
Mark Turner
Lee Furniss
Fiona Jones
6 months
September 2008
15. Fetal Cardiology:
This is an impressive service
but to optimise its
achievements an
appointment of additional
radiographer technician for
straight forward cases, a
dedicated rather than shared
echo machine for urgent
referrals and additional
consultant time for
counselling and training is
required.
Explore options to fund echo
machine
Further development of telemedicine
service
16. Teenage Transition:
Planning for the transition of
patients between Bristol
Children’s and the new Bristol
Heart Institute should accord
a high priority to the needs of
this group of patients
including in-patient provision
for adolescents and protected
cardiac catheter sessions.
17. Complex GUCH
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This has already been discussed
with Specialised Services and met
with unified agreement that this
should happen
Scope demand for service
Increase profile and knowledge base
of congenital heart disease within
the BHI
Surgery:
For some complex congenital
cardiac surgical lesions
consideration should be given
to operating on adult cases in
Bristol Children’s Hospital
where greater clinical
experience in management is
available.
This should be until such time
as the GUCH service is fully
facilitated, staffed and
funded, and is large enough
surgically to warrant in depth
specialisation of the whole
team in the Bristol Hearth
Institute.
This recommendation has not found
universal approval amongst the
clinical team. There are a number
of national framework documents
that would not support adults being
treated in a paediatric intensive care
unit
Consider anaesthetic and intensive
care skills required for complex adult
congential cardiac surgery
Dr Mark Turner
Dr Rob Martin
Ian Barrington
6 months
September 2008
Richard Downes
Ian Barrington
Geraldine Johnston
3 months
June 2008
6 months
September 2008
1 month
April 2008
Review SOPs for complex patients
including daily assessment by
trained clinical team members
across both Divisions
Consensus is that the clinical
expertise needs to go to the patient.
18. Perfusion:
That there be an increase in
the numbers of perfusionists
available for routine cases
and that there is a separate
on-call service for paediatric
cardiac perfusion.
The report states 8.77wte funded
perfusionists. This is incorrect, the
funded establishment at the time of
the review was and remains 10.8wte
A recently appointed perfusionist will
be able to provide on call from April
2008
Advertise for a student post to train
over two years
Cover services in interim with locum
agency
Review the feasability of a separate
on call service for paediatric cardiac
perfusion
19. ECMO Service:
Review of the provision of
ECMO.
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Perfusion protocols and procedures
reviewed January 2008 and going to
Sign off perfusion protocols at
CRAC
Richard Downes
Eamonn Nicholson
CRAC for sign off
PICU ECMO information pack
developed July 2007
Review PICU ECMO information
pack and roles and responsibilitie of
staff involved in ECMO
Ian Barrington
Geraldine Johnston
3 months
June 2008
Documented on Divisional Risk
Register
Orpheus Perfusion Simulator
purchased
New ECMO equipment purchased
for PICU (November 2006)
20. Perfusion:
Define roles and responsibilities of
the cardiac theatre team
Mr Andrew Parry
Prof Andy Wolf
Richard Downes
Hazel Moon
3 months
June 2008
The review alludes to cardiac
theatre and theatres in general.
A project looking at late starts is
underway (H Moon)
‘Lean’ project to be established to
look at the utilisation of BCH theatre
and indentity areas to improve
efficiency
Hazel Moon
Dr Peter Stoddart
Dr Philip Segar
Prof Andrew Wolf
Mr Andrew Parry
6 months
September 2008
Job description and job plan
completed for replacement post
To be presented to TOG for
agreement and sign off in March
2008
Mr Andrew Parry
Dr Andrew Tometzki
Geraldine Johnston
This month
March 2008
3 months
June 2008
Development of clear policies
which define roles and
responsibilities of all staff
within the cardiac theatre.
21. Cardiac Surgery:
Cardiac Surgery - clinical and
managerial review of
efficiency of current work
practices.
22. Cardiac Surgery:
Review of Consultant staffing.
Awaiting College approval
Advertise nationally and
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Presented to DMB for agreement
and sign off February 2008
internationally
Working with advertising agency to
develop advert
23. Cardiac Surgery:
Strategic review of the
provision of congenital
cardiac services over the next
5-10 years from a local,
regional and national view.
This should take account of
the possibility of closure of
units within the UK which may
or may not include Bristol.
Wide ranging discussions have
taken place over recent years with
no consensus. This is now the
subject of further debate by the
British Congenital Cardiac
Association
Engage in regional and national
discussion
Repeat of recommendation 4
See above
See recommendation 4
Dr Jackie Cornish
Dr Andrew Tometzki
Geraldine Johnston
12 months
March 2009
Include within Divisional Clinical
Strategy
24. Cardiac Anaesthesia:
Develop protocols for fast
tracking and consider
establishing a “Transitional”
nursing team to facilitate the
care of more high
dependency patients in Ward
32 or elsewhere if an area
can be identified.
We have an Outreach Team to
support high dependency patients
on wards
25. Cardiac
Surgery/Cardiology:
There is a need for clearer
policies to ensure morbidity
issues are discussed in a
more timely fashion
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This has been completed
Weekly discussion of all cardiac
surgical cases
Completed
Mr Andrew Parry
Dr James Fraser
Completed
November 2007
Clinical Governance framework in
place for urgent child
death/morbidity reviews
26. ECMO Policy:
Establish a policy for the
management of ECMO.
Repeat of recommendation 19
See above
See recommendation 19
27. Work Practice:
Clinicians and management
need urgently to review
current work practices.
Define roles, responsibilities and
expectations of team (link with
recommendation 21)
Dr Jackie Cornish
Dr Andrew Tometzki
Geraldine Johnston
6 months
September 2008
Support leadership development for
clinicians
6 months
September 2008
Review patient pathways using
‘lean’ methodology
6-12
months
March 2009
Responsibility for monitoring the implementation of the action plan – Dr J Cornish, Dr A Tometzki, G Johnston
AT/GJ 28 February 2008
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